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Cholesteatoma

Last reviewed: 3 Apr 2025
Last updated: 10 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • hearing loss
  • ear discharge resistant to antibiotic therapy
  • attic crust in retraction pocket
  • white mass behind intact tympanic membrane
Full details

Other diagnostic factors

  • tinnitus
  • otalgia
  • altered taste
  • dizziness
  • facial nerve weakness
Full details

Risk factors

  • middle ear disease
  • eustachian tube dysfunction
  • otologic surgery
  • traumatic blast injury to ear
  • congenital anomalies
  • family history
Full details

Diagnostic tests

1st tests to order

  • pure tone audiogram
  • CT scan of the petrous temporal bones
Full details

Tests to consider

  • fistula test
  • MRI scan of the head and petrous temporal bones
  • bacterial culture
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Susan A. Douglas, MBBS (Hons) UWI, FRCSEd, FRCS (ORL-HNS)

Consultant Otolaryngologist and Otologist

Rotherham NHS Foundation Trust

Rotherham

UK

Disclosures

SAD declares that she has no competing interests.

Peer reviewers

Cliff Megerian, MD

Professor and Vice Chairman of Otolaryngology

Case Western Reserve University School of Medicine

Cleveland

OH

Disclosures

CM is an author of a reference cited in this topic.

Iain Swan, MD, FRCS

Senior Lecturer in Otolaryngology

Honorary Consultant Otolaryngologist

Glasgow Royal Infirmary

Glasgow

UK

Disclosures

IS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kuo CL, Shiao AS, Yung M, et al. Updates and knowledge gaps in cholesteatoma research. Biomed Res Int. 2015;2015:854024.Full text  Abstract

Castle JT. Cholesteatoma pearls: practical points and update. Head Neck Pathol. 2018 Sep;12(3):419-29.Full text  Abstract

Isaacson G. Diagnosis of pediatric cholesteatoma. Pediatrics. 2007 Sep;120(3):603-8. Abstract

Bhutta MF, Williamson IG, Sudhoff HH. Cholesteatoma. BMJ. 2011 Mar 3;342:d1088. Abstract

Ayache D, Darrouzet V, Dubrulle F, et al. Imaging of non-operated cholesteatoma: clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis. 2012 Jun;129(3):148-52. Abstract

American College of Radiology. ACR appropriateness criteria: hearing loss and/or vertigo. 2018 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Cholesteatoma images
  • Differentials

    • Chronic suppurative otitis media
    • Otitis externa
    • Benign necrotizing otitis externa
    More Differentials
  • Guidelines

    • Hearing loss in adults: assessment and management
    • Otitis media with effusion in under 12s
    More Guidelines
  • Patient information

    Middle ear infection

    Outer ear infection

    More Patient information
  • Videos

    How to examine the ear

    More videos
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